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BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date 8/20/2019 <br />...................................._. Department _...__ <br />Name Brian Dono hue p Innovation <br />BPW Date 8/27/2019 Phone Extension 7652 <br />ffiffimmmmmp <br />Required Prior to Submittal to Board <br />Legal ® Attorney Name Kennedy <br />Controller ® Controller review is required for all Contracts $5,000.00 or more anc <br />greater than one year in length per the City Purchasing Policy <br />Purchasing <br />Check the <br />._ -.:....... � -----�--._��.-:...- <br />Z Agreement <br />El Professional Services <br />Bid Opening <br />❑ Quote Opening <br />❑ Change Order No. <br />❑ Ease/Encroach. <br />0 Other: <br />Nropriate Item Type <br />FI Contract <br />El Resolution <br />❑ Bid Award <br />El Quote Award <br />F] C/O & PCA No, <br />Traffic Control <br />- R guirqd for All Submissions <br />..._-. �.............�_ <br />Proposal El Addendum <br />❑ Req. to Advertise ❑ Title Sheet <br />uired Information <br />❑ PCA <br />Company or Vendor Name Ascend Indiana <br />New Vendor ® Yes ❑ No ❑ If Yes, Approved by Purchasing <br />MBE/WBE Contractor ❑ MBE ❑ WBE <br />MBE/WBE Contractor Requested ❑ No ❑ Yes Name of Company <br />Project Name <br />Project Number <br />._._........_........ . <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract 8/20/2019 — 8/20/2020 <br />Purpose/Description Free art' ation in recruitin ilot fo ou—i recent .�........., .........._. <br />ici � r s rc�n <br />undergraduates from Indiana, colleges and universities <br />® Required Contractor's Certification Form Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Vrif „ Iran, etc. <br />w.... <br />required For Chahe Orders Only <br />._...w.: <br />Amount of ❑ Increase $ <br />❑ Decrease $ <br />